4.5 Article

A proof of evidence supporting abnormal immunothrombosis in severe COVID-19: naked megakaryocyte nuclei increase in the bone marrow and lungs of critically ill patients

Journal

PLATELETS
Volume 31, Issue 8, Pages 1085-1089

Publisher

TAYLOR & FRANCIS INC
DOI: 10.1080/09537104.2020.1810224

Keywords

Coronavirus disease 2019 (COVID-19); immunothrombosis; interleukin-6 (IL-6); megakaryocytes; naked megakaryocyte nuclei; severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)

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Coronavirus disease 2019 (COVID-19) is a global public health emergency with many clinical facets, and new knowledge about its pathogenetic mechanisms is deemed necessary; among these, there are certainly coagulation disorders. In the history of medicine, autopsies and tissue sampling have played a fundamental role in order to understand the pathogenesis of emerging diseases, including infectious ones; compared to the past, histopathology can be now expanded by innovative techniques and modern technologies. For the first time in worldwide literature, we provide a detailed postmortem and biopsy report on the marked increase, up to 1 order of magnitude, of naked megakaryocyte nuclei in the bone marrow and lungs from serious COVID-19 patients. Most likely related to high interleukin-6 serum levels stimulating megakaryocytopoiesis, this phenomenon concurs to explain well the pulmonary abnormal immunothrombosis in these critically ill patients, all without molecular or electron microscopy signs of megakaryocyte infection.

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